Smile Assessment

5 Minute Smile Assessment

Are you happy are you with your current smile?
Our online assessment will take about 5 minutes and help us advise on how you can achieve a perfect smile!

How happy are you with the colour of your teeth? *

	1	2	3	4	5

1 is Not happy, 5 is Very happy

Do you feel that your teeth stick out or are they twisted /rotated? *

	1	2	3	4	5

1 is Very crooked, 5 is Not crooked at all

Do you have any missing teeth or gaps between your teeth? *

	1	2	3	4	5

1 is Large gaps or missing teeth, 5 is No gaps

A smile can be affected by having teeth which are either too long, too short, too wide or too narrow. *

	1	2	3	4	5

1 is Not proportionate, 5 is Well proportioned

Is the left side a mirror image of the right side? *

	1	2	3	4	5

1 is Not symmetrical, 5 is Very symmetrical

Ideally, your gum line should follow the line of the upper lip with minimum gum exposure when you smile *

	1	2	3	4	5

1 is My gums show a great deal , 5 is No gums show

About you
Your name *

First Name Last Name
Email
Only required if you would like us to send you free information on improving your smile
Phone
This is only required if you would like us to contact you
Any information you would like to add?
Would you be interested in a free Smile Consultation at our clinic in Swindon? *

Yes No
Would you like to upload a photo of your teeth / mouth?

Yes No
Upload a photo of your teeth

Click to upload

Cancel of
Your score is
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You are not happy with the colour of your teeth:

Solution: Teeth Whitening
Should be Empty:

About you